Take the wings of morning,

Entering medical school, you are warned of many things. It will be difficult, they say. It will be taxing, and rewarding, and perpetually challenging.

No one tells you it will be scary. It is.

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This week almost perfectly represents the quintessential Ateneo medical school experience. The only things missing are the standard small group discussions, patient encounters, and excursions out into the community. Still, I have missed over 20 hours of recommended sleep over the last several days.

Interschool athletic meets bracket the week (Ateneo’s making some sweeps). Tuesday meant studying for an exam on the female genitourinary system, Wednesday was a flipped classroom with the students taking charge. Earlier we had an exam on legal medicine, and tomorrow we’ll be presenting cases for financial accounting and management.

When I talk to relatives and non-medical friends, it’s easy to feel proud of what we learn in these settings. Every day is a step closer to mastering diagnosis and management.

Maybe I can name some drugs and mechanisms of action (not the dosages yet, which will be left for next year). I can name the risk factors and pathophysiology of the conditions we’re learning now (to be vaguely forgotten next week).

We talk over coffee and over the phone. I say I passed the exam. Sometimes barely, sometimes very well. I don’t mention the other things I learn, like the growing realization of responsibility. That I will become the executioner for the lives of the living, the dying, and still the dead, that every day of my future involves me being accountable for the future of others.

These are the things medical school also teaches.

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If death is inevitable, what rewards will we carry to our dreams? The gratitude of the living, given in thanks and in baskets of fruits. The money that barely covers our tuition, our training, and our risks. The frustrated envy of neighbors and the admiration of others. A white coat.

I wonder how I’ll feel when my first patient dies.
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Thanatology: the scientific study of death and the practices associated with it.

I look at predatory companies and incompetent policy-makers, and I need to know. Do they look at public health like it’s a myth? An annoying stitch in our unraveling post-factual reality? Statistics on paper and nothing else. Meaningless.

When big men encroach on the responsibilities of the medical sector, how can they live, taking everything but the notion of accountability?

Beneficence, non-maleficence, autonomy. Earlier this week I read a feature by The Guardian. Formula milk companies prey on the impoverished and the weak, targeting their vulnerable pockets and even more vulnerable dreams. Out of a Php1200 monthly income and budget, Php800 goes to unnecessary formulas. The baby gets sick because there’re scant resources for bottle sterilization, and the mother starves. Meanwhile, the commercials play –better IQ with formula! Medical representatives, against the law, advertise to facilities, dining them with conferences in the Ritz.

Beneficence, non-maleficence, autonomy. Vultures and murderers. I tune out the tweets and the posts on the country’s PAO. The authorities claim they’ve done forensic autopsy and histological examination, but they won’t allow external independent validation. There’s an expert that’s not an expert; there’s a lawyer dressed in scrubs cutting into public flesh. They feed into fear. There’s a measles outbreak in Zamboanga City.

Why are you here? If you’re here to take the burdens and the roles of health care, take them well.
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Beneficence, non-maleficence, autonomy. Again. The obstetrics module is a gold mine. I write now while it’s still fresh, one ear listening to our lecturer speak. It’s vivid: gauzes soaked with blood, women deciding against ligation or requesting for a cesarean delivery. Healthy women entering the operating room and maybe never coming back out.

I still wonder how anyone can ever think of medicine as glamorous. Behind every ‘well-cushioned’ private practitioner is a graduate who knows every complication and sequelae will be up to them. A careless decision now might mean a surgeon in the future, elbows-deep in blood. A patient returns to you, mostly in dreams –they’ve forgotten what good quality of life feels like, and they’re asking you.

Medicine begins to feel like a calling. You want to take over the world. Education, transportation, access to quality health care. Burn every superstitious myth and bridge every broken highway. The only thing on me now are my studies, but I want to take all of this too.

Everything is a driving force. It feeds my shame –why can’t I remember, why don’t I know? I imagine now there’s a battery behind every sleeping medical student, charged forward by the knowledge that we always have to be better.